Healthcare Provider Details

I. General information

NPI: 1174676001
Provider Name (Legal Business Name): TRAVIS WYATT MCCOY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 CALEDON CT SUITE C
GREENVILLE SC
29615-3170
US

IV. Provider business mailing address

17 CALEDON CT SUITE C
GREENVILLE SC
29615-3170
US

V. Phone/Fax

Practice location:
  • Phone: 864-232-7734
  • Fax: 864-232-7099
Mailing address:
  • Phone: 864-232-7734
  • Fax: 864-232-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number37787
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: